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Antibiotics Rarely Benefit Patients with Sinusitis
No subgroup of patients with sinusitis could be identified who might benefit more than others from antibiotics.
Physicians prescribe antibiotics for most patients who are diagnosed with acute sinusitis, but is this helpful? To find out, researchers performed a meta-analysis of data from nine randomized trials that involved 2547 immunocompetent adult patients with clinical symptoms of sinusitis who received either antibiotics or placebo. All trials excluded patients who had signs and symptoms (high fever, periorbital swelling, erythema, or intense facial pain) suggestive of serious complications that require antibiotic treatment.
Basing their analysis on individual patient data, the authors estimate that 15 patients overall would need to be treated with antibiotics for 1 patient to be cured; the number needed to treat dropped to 8 among patients with purulent pharyngeal discharge. Although patients who were older, reported longer symptom duration, or reported more severe symptoms took longer to cure, they were not more likely than others to benefit from antibiotics. No clinical signs or symptoms predicted a subgroup of patients who might benefit more from antibiotics, even among the subgroup of patients who reported having symptoms for longer than 7 to 10 days.
Comment: Overprescribing of antibiotics has finally diminished for the common cold and the "wait and see" approach is becoming more common for otitis media, but the prevalence of antibiotic prescribing for patients with sinusitis remains high. This study provides strong evidence that symptom relief is the only treatment needed for patients with simple sinusitis. Healthcare costs, adverse reactions, and drug resistance will all be reduced if we "just say no" to inappropriate requests for antibiotics.
Published in Journal Watch Emergency Medicine April 4, 2008
Citation(s):
Young J et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: A meta-analysis of individual patient data. Lancet 2008 Mar 15; 371:908.
- Medline abstract (Free)
Lindbaek M and Butler CC. Antibiotics for sinusitis-like symptoms in primary care. Lancet 2008 Mar 15; 371:874.
- Medline abstract (Free)